- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,150.00 / $3,683.00 / $8,400.00
| Facility | | $1,150.00 | $3,683.00 | $8,400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,132.98 / $14,509.07 / $22,924.17
| Facility | | $9,132.98 | $14,509.07 | $22,924.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,904.30 / $13,904.30 / $13,904.30
| Facility | | $13,904.30 | $13,904.30 | $13,904.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,086.49 / $1,634.40 / $6,889.15
| Facility | | $1,086.49 | $1,634.40 | $6,889.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,157.00 / $4,054.00 / $7,077.94
| Facility | | $1,157.00 | $4,054.00 | $7,077.94 |